‘I’m good now’: A focused ethnography of pregnant teenagers’ antenatal care needs in a region in Tasmania

Background The high teenage pregnancy rate in Tasmania, Australia, has been identified as an important health and wellbeing issue. Much of the international literature tends to problematise early childbearing as social, moral and economic issues. There is paucity of research in Australia, in particular, in Tasmania, on understanding the influence risk factors on pregnant teenagers’ antenatal care needs using interpretive qualitative analysis. Research aim This study examined the socio-ecological contexts in pregnant teenagers’ lives (aged 15–19 years) and the influence of these contexts on antenatal care needs in a region in Tasmania, Australia. Methodology and methods A two-phased interpretive qualitative exploratory research was conducted using focused ethnography and framed by the socio-ecological determinants of the health framework. Semi-structured interview was the data collection method applied. The two parts of phase I—(a) and (b)—were conducted sequentially (ante and post birth) with the teenagers. Phase II was conducted with midwives and nurses. Convenience sampling was undertaken with all research participants. All teenagers aged 15–19 years were recruited from a Young Mums Clinic (YMC). Midwives and nurses were recruited at a local hospital and the community-based c u @ home program, respectively. The research participants were 21 pregnant teenagers, 11 teenage mothers, nine midwives and six nurses. Thematic analysis and coding were conducted on all interview data. Triangulation of the findings from the four participant groups was conducted. The key findings from the triangulated process were further analysed using two theoretical frameworks. The novel application of structuration theory (Giddens, 1984) was important and contributed to current literature in this field of research. Finally, the teenagers’ antenatal care needs were inferred from felt (teenagers) and normative (midwives and nurses) needs (Carver, Ward & Talbot, 2002). Key findings Pregnancy was an important time for the teenagers. Many developed social agency, autonomy and control, ontological security and motivation for transformational change. The inferred key antenatal care needs were: access to alternative forms of childbirth education; healthy behaviours in relation to their diet, and cigarette smoking; understanding the realities of breastfeeding; and stress management skills. Social support was also an important need, in particular, short-term and long-term support for meaningful transformational change during pregnancy and beyond. Also, many teenagers’ were vulnerable to financial, housing, and transport issues. The social stigma of early childbearing was also a concern for some teenagers. Recommendations At the micro-level, the teenagers’ antenatal care needs (healthy behaviours on diet, reduction of cigarette smoking, breastfeeding, stress) can be addressed via improved access to quality teen-centred care and childbirth education information using participatory and current information technology and communication strategies. More sustained support and help from social support networks could be useful, to address stress related to childbearing, and for transformational life changes. At the exo-level, midwifery practice could be enhanced at the local hospital via a participatory, teen-centred approach. Macro-level recomendations aim to influence policy level changes, to reduce the socio-ecological determinants’ influence on early childbearing in Tasmania